Sri Lanka's Successful Containment of COVID-19 Through Its Rapid and Early Response: Clinical & Epidemiological Evidence from the Initial Case Series

Background: Despite the rising global burden, Sri Lanka reports a relatively low caseload and mortality for COVID-19. This warrants exploration of the initial response of Sri Lanka to the pandemic, based on clinical and epidemiological characteristics of the case series during the initial passive case detection phase in Sri Lanka.Methods: A retrospective study was conducted using secondary data (hospital records and investigation reports) extracted from all laboratory-confirmed patients admitted to the three main state-sector hospitals in Sri Lanka from 11 March to 7 April 2020. Clinical outcomes were categorized as mild, severe and critical, as per the international classification. Kruskal-Wallis, Mann Whitney U and Fisher’s exact tests compared differences between the variables.Findings: The case series comprised 146 discharges and six deaths. Majority were males (63.2%); mean age of 40.9 (SD=17.9); and symptomatic (72.4%). Sixty-one (40.1%) had co-morbidities, the commonest being diabetes (20.4%) and hypertension (17.8%). Mild (93.4%), severe (2.6%) and critical (4.0%) disease outcomes were noted. Disease severity was significantly higher with older age (p=0.037), co-morbidities (p=0.026); and higher white-cell (p=0.045) and lymphocyte (p=0.043) counts; but not with being symptomatic (p=0.683). The commonest symptoms were fever (62.5%), dry cough (48.0%) and sore throat (26.9%). The median duration (IQR) was 3.0 days (1.0-5.0) and 18.0 (15.0-29.5), respectively before and during hospitalization.Interpretation: In contrast to high-risk countries, the younger age and milder disease portrayed in local patients reflect the success of early response to the pandemic in Sri Lanka. However, the factors determining disease fatality remain the same as in other countries.Funding Statement: World Health Organization, Country Office, Sri LankaDeclaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: Ethical clearance for this study was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Colombo, Sri Lanka. Administrative clearance for data collection was obtained from the Director General of Health Services in Sri Lanka and from all institutional heads.